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166ASSESSMENT OF ANTIBIOTIC PRESCRIBING PRACTICES FOR WOMEN DURING AND AFTER DELIVERY IN A NON-TEACHING TERTIARY CARE HOSPITAL IN UJJAIN,
INDIA: A PROSPECTIVE CROSS-SECTIONAL ANALYSIS
Golla Lavanya
Asst. Professor, Department of Pharmaceutical Analysis, Princeton College of Pharmacy, Hyderabad, Telangana, India
Kadasi Sundeep
Asst. Professor, Department of Pharmaceutical Analysis, Princeton College of Pharmacy, Hyderabad, Telangana, India
Abstract-
Objectives: In order to reduce maternal mortality, antibacterial medications, also referred to as antibiotics, are essential for treating infections during delivery and the postpartum period. Although extensive use of antibiotics contributes to the development and spread of antibiotic resistance, institutional deliveries have the potential to save the lives of many women. In a non-teaching tertiary care hospital in the city of Ujjain, Madhya Pradesh, India, the purpose of this study was to document antibiotic prescribing among inpatients during and after delivery.
Methods: Women who had undergone a hospital cesarean section or vaginal delivery were included in a prospective cross-sectional study. Using a specific form attached to each patient's file, trained nursing staff collected the data daily. The data was analyzed using logistic regression, both bivariate and multivariate.
Results: 566 (53%) of the 1077 women gave birth naturally, while 511 (47%) had a cesarean section. Antibiotics were prescribed to 87% of women who had a vaginal birth and 98% of women who had a cesarean section. Women who delivered via vaginal delivery spent an average of 3.1 (1.7) days on antibiotics in the hospital, while those who delivered via cesarean section spent an average of 6.0 (2.5) days. At discharge, antibiotics were prescribed to 28% of women who had cesarean sections as well as vaginal deliveries. The most regularly recommended anti-toxin bunch in the clinic for both the ladies that had a vaginal conveyance and the ladies that had a cesarean segment were third-age cephalosporins (J01DD). For women who had a vaginal delivery, the total number of defined daily doses (DDD) per 100 bed days was 101, while for women who had a cesarean section, the number was 127.
Conclusions: Concerns include the high rate of women who delivered via vaginal birth who received antibiotics and the hospital's disregard for cesarean section recommendations. The rational use of antibiotics and improved maternal health are intertwined. In health care facilities, it is necessary to have a specific policy and set of guidelines for how to prescribe antibiotics during delivery. Additionally, a system for monitoring antibiotic prescribing and resistance must be developed and put into action.
Keywords: Prescription of antibiotics, vaginal birth, c-section, non-teaching hospital in Ujjain, Madhya Pradesh, India.
1 INTRODUCTION
In order to reduce maternal mortality, it is essential that antibacterial medications—
also referred to as antibiotics—be made available for the treatment of infections that occur during labor and after delivery.
Worldwide, approximately 350 000
maternal deaths occur annually.
Infections are one of the leading causes of maternal mortality. The World Health Organization (WHO) says that infections are directly responsible for 15% of all maternal deaths worldwide. Other studies
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167 say that infections are responsible for asmany as 30% of all maternal deaths worldwide. Between 1990 and 2008, India's national maternal mortality rate (MMR) decreased significantly from 570 to 230 per 100,000 live births. In any case, the general typical speed of the decrease in MMR shows that India won't arrive at the Thousand years Advancement Objective (MDG) of 108 out of 2015. The MMR is predicted to be around 135 by 2015, according to recent estimates. The majority of all maternal deaths worldwide take place during labor and postpartum.
Increasing access to emergency obstetric care, which frequently necessitates having access to antibiotics, is one of the single most significant interventions that can be implemented to reduce maternal mortality.
Increased access to health care interventions, including antibiotics, is necessary to prevent infection-related maternal deaths. However, due to the emergence of antibiotic resistance, caution must also be exercised when prescribing antibiotics. Antibiotics are widely used in India because they can be easily obtained without a prescription and are frequently prescribed by medical professionals. Antibiotic prescribing rates have been found to be higher in primary and secondary health care facilities in India [8-10]. In the Indian context, antibiotic prescription rates during and after delivery are unknown, but it is likely that both over- and under-prescribing occurs.
In a tertiary care hospital in the city of Ujjain, Madhya Pradesh, India, the purpose of this study was to report on the prevalence, types, and duration of antibiotics prescribed to women during and after vaginal delivery or caesarean section.
2 METHODS SETTING
Madhya Pradesh, home to Ujjain, is one of India's most populous and largest states, both geographically and in terms of
population. Madhya Pradesh's maternal health indicators rank among the lowest in India. 47% of deliveries take place at a health facility, ranging from 13% in Dindori district to 79% in Indore district, according to data from the district level household and family survey that was conducted in 2007–2008. Sixty-six percent of women in Madhya Pradesh had experienced at least one complication during labor, and forty-one percent had experienced complications following delivery, such as a high fever and abdominal pain. Ninety percent of women in the Ujjain district where this study's data were gathered received antenatal care, and sixty-eight percent gave birth in a hospital. In Madhya Pradesh, there is no general surveillance system to keep an eye on antibiotic prescribing or antibiotic resistance. However, studies that were carried out in Madhya Pradesh and the Ujjain district revealed that overall, high prescribing rates were observed among both admitted and outpatient patients.
Neither anti-toxin recommending rules overall nor explicit rules for endorsing of anti-toxins during vaginal conveyance or for obstetric medical procedure were accessible at the clinic at the hour of the review.
3 DATA COLLECTION
At the VD Gardi Charitable Trust Hospital and Research Centre, data were collected in a prospective cross sectional design from April 2008 to December 2010. The hospital has 350 beds and is run by the Ujjain Charitable Trust, a non-profit organization. Patients pay a small fee for consultation and treatment at the hospital, which is a non-educational facility in the city of Ujjain. The hospital serves both the urban and rural populations of the cities' neighboring villages. This study drew on a substantial set of data compiled by the research team regarding antibiotic prescriptions at this hospital. Using a specific form attached to each patient's file, trained nursing staff
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168 collected the data daily. The procedure forgathering data has previously been described in detail.
3.1 Data Management and Analysis Epi info (version 3.1) and Excel were used to enter the data, and SPSS (version 21.0) and Stata (version 12.1), both from Texas, USA, were used to conduct the analyses.
The fundamental variable, recommending of anti-microbials, was examined independently for the gathering of ladies who had a vaginal conveyance and for the gathering of ladies that had a cesarean segment. The mean number of days for which antibiotics were prescribed, as well as the prescribing by age group, residence, and number of days spent in the hospital, were all determined using descriptive statistics. For the vaginal deliveries, a bivariate and multivariable logistic regression was used to examine the relationship between the binary outcome of antibiotic prescriptions (yes or no) and the following variables: age (18–
20, 21–30, or older than 31), residence (Ujjain city, nearby city, Ujjain district villages, other districts, cities in the nearby district, other district villages), and number of days in the hospital (1–2, 3–5, or more than 5). The term 'OR' has been utilized for the chances proportion of bivariate and 'adj. In both the text and the tables, the term "OR" stands for the odds ratio of multivariate logistic regressions.
The prescribed antibiotic was classified according to the Anatomical Therapeutic Chemical (ATC) classification system and the defined daily dose (DDD). The DDD is the assumed average maintenance dose per day for a drug when used for its primary indication in adults, and the ATC system categorizes the active substances into groups and subgroups. The DDD provides a fixed unit of measurement that is independent of things like strength and price, making it possible to study drug prescribing patterns. The total DDD and DDD/100 bed days were used in this
study to show that antibiotics were being prescribed.
3.2 Methodological Considerations One of the strength of this study is the detailed record of prescribing data on individual patients throughout their hospital stay. In addition, the data includes discharge prescription. The data collection process, with data collected daily by trained hospital staff, is an additional strength. The topic of this study was multifaceted and for this purpose the composition of the group of researchers included competence in drug use, obstetrics, statistics and policy science. The lack of data on socioeconomic status limits the possibilities of comparing antibiotic prescriptions between different economic and social classes. Lack of information on proportion of the assisted or non-assisted vaginal deliveries is a further weakness of the study.
4 CONCLUSIONS AND POLICY IMPLICATIONS
Concerns include the high rate of antibiotic prescriptions for vaginal delivery patients and hospital deviations from cesarean section recommendations.
Antibiotics are routinely prescribed for prophylactic purposes to women who have both normal and operative vaginal deliveries in this setting, as evidenced by the widespread use of antibiotics in vaginal delivery. Both the benefits of prophylactic antibiotic prescribing during assisted vaginal deliveries and the perceived benefits of antibiotic prescribing during non-assisted vaginal deliveries among health professionals require additional investigation into this practice.
The rational use of antibiotics and improved maternal health are intertwined.
As a means of reducing maternal mortality, the Indian government is advocating for institutional delivery. The number of hospital inpatients will significantly rise as a result of this
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169 strategy; This highlights the need for aspecific policy in healthcare facilities regarding when and how to prescribe antibiotics during and after delivery.
Additionally, a system for monitoring antibiotic prescribing and resistance must be developed and put into action. Several interventions are intertwined, as is typical of policy development and implementation. Policy on antibiotic prescribing must be linked to policy on interventions, such as improving postpartum care, where a large number of infections occur, and infection control measures like hand hygiene.
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